A short-acting hypnotic-sedative drug with anxiolytic and amnestic properties. It is used in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. The short duration and cardiorespiratory stability makes it useful in poor-risk, elderly, and cardiac patients. It is water-soluble at pH less than 4 and lipid-soluble at physiological pH.
Drugs used to induce drowsiness or sleep or to reduce psychological excitement or anxiety.
A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway. (From: American Society of Anesthesiologists Practice Guidelines)
Agents that alleviate ANXIETY, tension, and ANXIETY DISORDERS, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. ADRENERGIC BETA-ANTAGONISTS are commonly used in the symptomatic treatment of anxiety but are not included here.
Drugs administered before an anesthetic to decrease a patient's anxiety and control the effects of that anesthetic.
A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses.
A group of two-ring heterocyclic compounds consisting of a benzene ring fused to a diazepine ring.
Agents that are administered in association with anesthetics to increase effectiveness, improve delivery, or decrease required dosage.
A cytochrome P-450 suptype that has specificity for a broad variety of lipophilic compounds, including STEROIDS; FATTY ACIDS; and XENOBIOTICS. This enzyme has clinical significance due to its ability to metabolize a diverse array of clinically important drugs such as CYCLOSPORINE; VERAPAMIL; and MIDAZOLAM. This enzyme also catalyzes the N-demethylation of ERYTHROMYCIN.
Substances that do not act as agonists or antagonists but do affect the GAMMA-AMINOBUTYRIC ACID receptor-ionophore complex. GABA-A receptors (RECEPTORS, GABA-A) appear to have at least three allosteric sites at which modulators act: a site at which BENZODIAZEPINES act by increasing the opening frequency of GAMMA-AMINOBUTYRIC ACID-activated chloride channels; a site at which BARBITURATES act to prolong the duration of channel opening; and a site at which some steroids may act. GENERAL ANESTHETICS probably act at least partly by potentiating GABAergic responses, but they are not included here.
Ultrashort-acting anesthetics that are used for induction. Loss of consciousness is rapid and induction is pleasant, but there is no muscle relaxation and reflexes frequently are not reduced adequately. Repeated administration results in accumulation and prolongs the recovery time. Since these agents have little if any analgesic activity, they are seldom used alone except in brief minor procedures. (From AMA Drug Evaluations Annual, 1994, p174)
A range of methods used to reduce pain and anxiety during dental procedures.
An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. (From Smith and Reynard, Textbook of Pharmacology, 1992, 1st ed, p206). Propofol has been used as ANTICONVULSANTS and ANTIEMETICS.
A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (RECEPTORS, N-METHYL-D-ASPARTATE) and may interact with sigma receptors.
A benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant, and amnesic properties and a long duration of action. Its actions are mediated by enhancement of GAMMA-AMINOBUTYRIC ACID activity.
The period of emergence from general anesthesia, where different elements of consciousness return at different rates.
Administration of a soluble dosage form between the cheek and gingiva. It may involve direct application of a drug onto the buccal mucosa, as by painting or spraying.
A potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Fentanyl is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1078)
The action of a drug that may affect the activity, metabolism, or toxicity of another drug.
A histamine H1 receptor antagonist that is effective in the treatment of chronic urticaria, dermatitis, and histamine-mediated pruritus. Unlike its major metabolite CETIRIZINE, it does cause drowsiness. It is also effective as an antiemetic, for relief of anxiety and tension, and as a sedative.
A benzodiazepine used in the treatment of anxiety, alcohol withdrawal, and insomnia.
The use of two or more chemicals simultaneously or sequentially to induce anesthesia. The drugs need not be in the same dosage form.
Drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposely following repeated painful stimulation. The ability to independently maintain ventilatory function may be impaired. (From: American Society of Anesthesiologists Practice Guidelines)
Preliminary administration of a drug preceding a diagnostic, therapeutic, or surgical procedure. The commonest types of premedication are antibiotics (ANTIBIOTIC PROPHYLAXIS) and anti-anxiety agents. It does not include PREANESTHETIC MEDICATION.
A imidazole derivative that is an agonist of ADRENERGIC ALPHA-2 RECEPTORS. It is closely-related to MEDETOMIDINE, which is the racemic form of this compound.
A barbiturate that is administered intravenously for the induction of general anesthesia or for the production of complete anesthesia of short duration.
A short-acting opioid anesthetic and analgesic derivative of FENTANYL. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients.
Injections made into a vein for therapeutic or experimental purposes.
Process of administering an anesthetic through injection directly into the bloodstream.
Intravenous anesthetics that induce a state of sedation, immobility, amnesia, and marked analgesia. Subjects may experience a strong feeling of dissociation from the environment. The condition produced is similar to NEUROLEPTANALGESIA, but is brought about by the administration of a single drug. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed)
Oxidoreductases, N-Demethylating are enzymes that catalyze the oxidation of N-methyl groups to carbonyl groups, typically found in xenobiotic metabolism, involving the removal of methyl groups from various substrates using molecular oxygen.
A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment.
Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general ANESTHESIA, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site.
A short-acting benzodiazepine used in the treatment of insomnia. Some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. Its use at lower doses with appropriate care and labeling has been reaffirmed by the FDA and most other countries.
A superfamily of hundreds of closely related HEMEPROTEINS found throughout the phylogenetic spectrum, from animals, plants, fungi, to bacteria. They include numerous complex monooxygenases (MIXED FUNCTION OXYGENASES). In animals, these P-450 enzymes serve two major functions: (1) biosynthesis of steroids, fatty acids, and bile acids; (2) metabolism of endogenous and a wide variety of exogenous substrates, such as toxins and drugs (BIOTRANSFORMATION). They are classified, according to their sequence similarities rather than functions, into CYP gene families (>40% homology) and subfamilies (>59% homology). For example, enzymes from the CYP1, CYP2, and CYP3 gene families are responsible for most drug metabolism.
Abnormal fear or dread of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures.
A benzodiazepine used as an anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent.
Delivery of medications through the nasal mucosa.
The insertion of drugs into the rectum, usually for confused or incompetent patients, like children, infants, and the very old or comatose.
Placing of a hydroxyl group on a compound in a position where one did not exist before. (Stedman, 26th ed)
Imidazole derivative anesthetic and hypnotic with little effect on blood gases, ventilation, or the cardiovascular system. It has been proposed as an induction anesthetic.
The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity.

Quantitative prediction of metabolic inhibition of midazolam by itraconazole and ketoconazole in rats: implication of concentrative uptake of inhibitors into liver. (1/994)

To evaluate the extent of drug-drug interaction concerning metabolic inhibition in the liver quantitatively, we tried to predict the plasma concentration increasing ratio of midazolam (MDZ) by itraconazole (ITZ) or ketoconazole (KTZ) in rats. MDZ was administered at a dose of 10 mg/kg through the portal vein at 60 min after bolus administration of 20 mg/kg ITZ or during 0.33 mg/h/body of KTZ infusion. The ratio values in the area under the plasma concentration curve of MDZ in the presence of ITZ and KTZ was 2.14 and 1.67, respectively. The liver-unbound concentration to plasma-unbound concentration ratios of ITZ and KTZ were 11 approximately 14 and 1.3, respectively, suggesting a concentrative uptake of both drugs into the liver. ITZ and KTZ competitively inhibited the oxidative metabolism of MDZ in rat liver microsomes, and Ki values of ITZ and KTZ were 0.23 microM and 0.16 microM, respectively. We predicted the ratio values of MDZ in the presence of ITZ and KTZ, using Ki values and unbound concentrations of both drugs in the plasma or liver. The predicted ratio values in the presence of ITZ or KTZ calculated by using unbound concentration in the plasma were 1.03 approximately 1.05 and 1.39, whereas those calculated using unbound concentration in the liver were 1.73 approximately 1.97 and 1.51, respectively, which were very close to the observed ratio values. These findings indicated the necessity to consider the concentrative uptake of inhibitors into the liver for the quantitative prediction of the drug-drug interactions concerning metabolic inhibition in the liver.  (+info)

Postoperative behavioral outcomes in children: effects of sedative premedication. (2/994)

BACKGROUND: Although multiple studies document the effect of sedative premedication on preoperative anxiety in children, there is a paucity of data regarding its effect on postoperative behavioral outcomes. METHODS: After screening for recent stressful life events, children undergoing anesthesia and surgery were assigned randomly to receive either 0.5 mg/kg midazolam in 15 mg/kg acetaminophen orally (n = 43) or 15 mg/kg acetaminophen orally (n = 43). Using validated measures of anxiety, children were evaluated before and after administration of the intervention and during induction of anesthesia. On postoperative days 1, 2, 3, 7, and 14, the behavioral recovery of the children was assessed using the Post Hospitalization Behavior Questionnaire. RESULTS: The intervention group demonstrated significantly lower anxiety levels compared with the placebo group on separation to the operating room and during induction of anesthesia (F[1,77] = 3.95, P = 0.041). Using a multivariate logistic regression model, the authors found that the presence or absence of postoperative behavioral changes was dependent on the group assignment (R = 0.18, P = 0.0001) and days after operation (R = -0.20, P = 0.0001). Post hoc analysis demonstrated that during postoperative days 1-7, a significantly smaller number of children in the midazolam group manifested negative behavioral changes. At week 2 postoperatively, however, there were no significant differences between the midazolam and placebo groups. CONCLUSIONS: Children who are premedicated with midazolam before surgery have fewer negative behavioral changes during the first postoperative week.  (+info)

Effect of butorphanol tartrate on shock-related discomfort during internal atrial defibrillation. (3/994)

BACKGROUND: In patients with atrial fibrillation, intracardiac atrial defibrillation causes discomfort. An easily applicable, short-acting analgesic and anxiolytic drug would increase acceptability of this new treatment mode. METHODS AND RESULTS: In a double-blind, placebo-controlled manner, the effect of intranasal butorphanol, an opioid, was evaluated in 47 patients with the use of a step-up internal atrial defibrillation protocol (stage I). On request, additional butorphanol was administered and the step-up protocol continued (stage II). Thereafter, if necessary, patients were intravenously sedated (stage III). After each shock, the McGill Pain Questionnaire was used to obtain a sensory (S), affective (A), evaluative (E), and total (T) pain rating index (PRI) and a visual analogue scale analyzing pain (VAS-P) and fear (VAS-F). For every patient, the slope of each pain or fear parameter against the shock number was calculated and individual slopes were averaged for the placebo and butorphanol group. All patients were cardioverted at a mean threshold of 4.4+/-3.3 J. Comparing both patient groups for stage II, the mean slopes for PRI-T (P=0.0099), PRI-S (P=0.019), and PRI-E (P=0.015) became significantly lower in the butorphanol group than in the placebo group. Comparing patients who received the same shock intensity ending stage I and going to stage II, in those patients randomized to placebo the mean VAS-P (P=0.023), PRI-T (P=0. 029), PRI-S (P=0.030), and PRI-E (P=0.023) became significantly lower after butorphanol administration. CONCLUSIONS: During a step-up internal atrial defibrillation protocol, intranasal butorphanol decreased or stabilized the value of several pain variables and did not affect fear. Of the 3 qualitative components of pain, only the affective component was not influenced by butorphanol. The PRI evaluated pain more accurately than the VAS.  (+info)

Intranasal midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intra-observer variability. (4/994)

Midazolam is often used for paediatric premedication. We have compared two methods of administering midazolam intranasally in 44 surgical day-case children allocated randomly to receive midazolam 0.2 mg kg-1 as drops or midazolam 0.1 mg kg-1 from an intranasal spray device. Behaviour was recorded on a four-point scale by the parent, nurse and anaesthetist. Coefficients were obtained representing the change in behaviour score. There was no significant difference in method of administration (coefficient 0.13, P = 0.39). Children were significantly more distressed at the time of premedication and at the time of venous cannulation (coefficients 1.31 and 0.70) than at baseline. There was no significant difference in the assessments between observers. Midazolam by either method was equally effective but acceptability of the premedication was poor in both groups. Intranasal midazolam cannot be recommended as a method for routine premedication of young children.  (+info)

Sedation depends on the level of sensory block induced by spinal anaesthesia. (5/994)

We have investigated the relationship between the extent of spinal block and occurrence of sedation. In a first series of 43 patients, the distribution of sedation score (measured on the Ramsey scale) was related to the extent of spinal block (pinprick). In a second series of 33 patients, the relationship between sedation score and spinal block persisted after injection of midazolam 1 mg. This study confirmed that high spinal block was associated with increased sedation.  (+info)

Characterization of the pharmacodynamic interaction between parent drug and active metabolite in vivo: midazolam and alpha-OH-midazolam. (6/994)

The pharmacodynamic interaction between midazolam and its active metabolite alpha-OH-midazolam was investigated to evaluate whether estimates of relevant pharmacodynamic parameters are possible after administration of a mixture of the two. Rats were administered 10 mg/kg of midazolam, 15 mg/kg of alpha-OH-midazolam, or a combination of 3.6 mg/kg of midazolam and 35 mg/kg of alpha-OH-midazolam. Increase in the 11.5- to 30-Hz frequency band of the electroencephalogram was used as the pharmacodynamic endpoint. The pharmacodynamics of midazolam and alpha-OH-midazolam after combined administration were first analyzed according to an empirical and a competitive interaction model to evaluate each model's capability in retrieving the pharmacodynamic estimates of both compounds. Both models failed to accurately estimate the true pharmacodynamic estimates of midazolam and alpha-OH-midazolam. The pharmacodynamic interaction was subsequently analyzed according to a new mechanism-based model. This approach is based on classical receptor theory and allows estimation of the in vivo estimated receptor affinity and intrinsic in vivo drug efficacy. The relationship between stimulus and effect is characterized by a monotonically increasing function f, which is assumed to be identical for midazolam and alpha-OH-midazolam. The pharmacodynamic interaction is characterized by the classical equation for the competition between two substrates for a common receptor site. This mechanism-based interaction model was able to estimate the pharmacodynamic parameters of both midazolam and alpha-OH-midazolam with high accuracy. It is concluded that pharmacodynamic parameters of single drugs can be estimated after a combined administration when a mechanistically valid interaction model is applied.  (+info)

First-pass midazolam metabolism catalyzed by 1alpha,25-dihydroxy vitamin D3-modified Caco-2 cell monolayers. (7/994)

Cytochrome P-450 (CYP) 3A4 accounts for approximately 50% of all P-450s found in the small intestine (Paine et al., 1997) and contributes to the extensive and variable first-pass extraction of drugs such as cyclosporine and saquinavir. We recently demonstrated that CYP3A4 expression in a differentiated Caco-2 subclone is increased when cell monolayers are treated with 1alpha,25-dihydroxy-vitamin-D3 (Schmiedlin-Ren et al., 1997). This improved metabolic capacity permits the in vitro modeling of first-pass intestinal metabolic kinetics. Midazolam (MDZ) 1'-hydroxylation was used as a specific probe for CYP3A-mediated metabolism in modified Caco-2 monolayers. Caco-2 cells were grown to confluence on laminin-coated culture inserts, and then for two additional weeks in the presence of 1alpha,25-dihydroxy vitamin-D3. Cell monolayers were subsequently exposed to MDZ for varying lengths of time and concentrations. The amount of MDZ in the monolayer increased rapidly after apical drug administration, reaching a pseudo steady state within 6 min. The cellular uptake rate was considerably slower after a basolateral dose. By either route of administration, the rate of 1'-hydroxymidazolam formation was stable and linear for 2 h. Under basolateral sink conditions and low apical MDZ dosing concentration (1-8 microM), the first-pass extraction ratio was found to be approximately 15%. Higher dosing concentrations led to saturation of the hydroxylation reaction and reduction in the extraction ratio. The modified Caco-2 cell monolayer is an excellent model for studying drug absorption and first-pass intestinal metabolic kinetic processes. In this system, the selective CYP3A probe MDZ was rapidly absorbed, yet extensively metabolized, as is observed in vivo.  (+info)

Midazolam metabolism by modified Caco-2 monolayers: effects of extracellular protein binding. (8/994)

It has been suggested that the binding of a drug to plasma proteins will influence the intestinal extraction efficiency when drug is delivered to the mucosal epithelium via either the gut lumen or vasculature. We evaluated this hypothesis using cytochrome P-450 (CYP)3A4-expressing Caco-2 monolayers as a model for the intestinal epithelial barrier and midazolam as a CYP3A-specific enzyme probe. The rate of 1'-hydroxylation was measured following apical or basolateral midazolam administration to monolayers incubated in the presence or absence of 4 g/dl of human serum albumin (HSA) in the basolateral compartment medium. The midazolam-free fraction in culture medium containing HSA was 3.3%. Inclusion of HSA in the basolateral medium decreased peak intracellular midazolam accumulation after an apical midazolam dose (3 microM) by 35% and reduced the 1'-hydroxymidazolam formation rate by approximately 20%. Because of the accelerated diffusion of midazolam through the cell monolayer and into the basolateral compartment, there was a 61% reduction in the first-pass metabolic extraction ratio: 13.3 +/- 0. 12% for control versus 5.2 +/- 1% with HSA. Compared with control, addition of HSA resulted in a 91% decrease in the peak intracellular midazolam level and a 86% decrease in the rate of 1'-hydroxylation after the administration of midazolam into basolateral medium. These findings suggest that, in vivo, binding of a drug to plasma proteins will impact both first-pass and systemic intestinal midazolam extraction efficiency. Furthermore, the effect will be more pronounced for a drug that is delivered to mucosal enterocytes by way of arterial blood, compared with oral drug delivery.  (+info)

Midazolam is a medication from the class of drugs known as benzodiazepines. It works by enhancing the effect of a neurotransmitter called gamma-aminobutyric acid (GABA), which has a calming effect on the brain and nervous system. Midazolam is often used for its sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties.

Medically, midazolam is used for various purposes, including:

1. Preoperative medication (sedation before surgery)
2. Procedural sedation (for minor surgical or diagnostic procedures)
3. Treatment of seizures (status epilepticus)
4. Sedation in critically ill patients
5. As an adjunct to anesthesia during surgeries
6. Treatment of alcohol withdrawal symptoms
7. To induce amnesia for certain medical or dental procedures

Midazolam is available in various forms, such as tablets, intravenous (IV) solutions, and intranasal sprays. It has a rapid onset of action and a short duration, making it suitable for brief, intermittent procedures. However, midazolam can cause side effects like drowsiness, confusion, respiratory depression, and memory impairment. Therefore, its use should be carefully monitored by healthcare professionals.

Hypnotics and sedatives are classes of medications that have depressant effects on the central nervous system, leading to sedation (calming or inducing sleep), reduction in anxiety, and in some cases, decreased awareness or memory. These agents work by affecting the neurotransmitter GABA (gamma-aminobutyric acid) in the brain, which results in inhibitory effects on neuronal activity.

Hypnotics are primarily used for the treatment of insomnia and other sleep disorders, while sedatives are often prescribed to manage anxiety or to produce a calming effect before medical procedures. Some medications can function as both hypnotics and sedatives, depending on the dosage and specific formulation. Common examples of these medications include benzodiazepines (such as diazepam and lorazepam), non-benzodiazepine hypnotics (such as zolpidem and eszopiclone), barbiturates, and certain antihistamines.

It is essential to use these medications under the guidance of a healthcare professional, as they can have potential side effects, such as drowsiness, dizziness, confusion, and impaired coordination. Additionally, long-term use or high doses may lead to tolerance, dependence, and withdrawal symptoms upon discontinuation.

Conscious sedation, also known as procedural sedation and analgesia, is a minimally depressed level of consciousness that retains the patient's ability to maintain airway spontaneously and respond appropriately to physical stimulation and verbal commands. It is typically achieved through the administration of sedative and/or analgesic medications and is commonly used in medical procedures that do not require general anesthesia. The goal of conscious sedation is to provide a comfortable and anxiety-free experience for the patient while ensuring their safety throughout the procedure.

Anti-anxiety agents, also known as anxiolytics, are a class of medications used to manage symptoms of anxiety disorders. These drugs work by reducing the abnormal excitement in the brain and promoting relaxation and calmness. They include several types of medications such as benzodiazepines, azapirone, antihistamines, and beta-blockers.

Benzodiazepines are the most commonly prescribed anti-anxiety agents. They work by enhancing the inhibitory effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which results in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties. Examples of benzodiazepines include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

Azapirones are a newer class of anti-anxiety agents that act on serotonin receptors in the brain. Buspirone (Buspar) is an example of this type of medication, which has fewer side effects and less potential for abuse compared to benzodiazepines.

Antihistamines are medications that are primarily used to treat allergies but can also have anti-anxiety effects due to their sedative properties. Examples include hydroxyzine (Vistaril, Atarax) and diphenhydramine (Benadryl).

Beta-blockers are mainly used to treat high blood pressure and heart conditions but can also help manage symptoms of anxiety such as rapid heartbeat, tremors, and sweating. Propranolol (Inderal) is an example of a beta-blocker used for this purpose.

It's important to note that anti-anxiety agents should be used under the guidance of a healthcare professional, as they can have side effects and potential for dependence or addiction. Additionally, these medications are often used in combination with psychotherapy and lifestyle modifications to manage anxiety disorders effectively.

Preanesthetic medication, also known as premedication, refers to the administration of medications before anesthesia to help prepare the patient for the upcoming procedure. These medications can serve various purposes, such as:

1. Anxiolysis: Reducing anxiety and promoting relaxation in patients before surgery.
2. Amnesia: Causing temporary memory loss to help patients forget the events leading up to the surgery.
3. Analgesia: Providing pain relief to minimize discomfort during and after the procedure.
4. Antisialagogue: Decreasing saliva production to reduce the risk of aspiration during intubation.
5. Bronchodilation: Relaxing bronchial smooth muscles, which can help improve respiratory function in patients with obstructive lung diseases.
6. Antiemetic: Preventing or reducing the likelihood of postoperative nausea and vomiting.
7. Sedation: Inducing a state of calmness and drowsiness to facilitate a smooth induction of anesthesia.

Common preanesthetic medications include benzodiazepines (e.g., midazolam), opioids (e.g., fentanyl), anticholinergics (e.g., glycopyrrolate), and H1-antihistamines (e.g., diphenhydramine). The choice of preanesthetic medication depends on the patient's medical history, comorbidities, and the type of anesthesia to be administered.

Flumazenil is a medication that acts as a competitive antagonist at benzodiazepine receptors. It is primarily used in clinical settings to reverse the effects of benzodiazepines, which are commonly prescribed for their sedative, muscle relaxant, and anxiety-reducing properties. Flumazenil can reverse symptoms such as excessive sedation, respiratory depression, and impaired consciousness caused by benzodiazepine overdose or adverse reactions. It is important to note that flumazenil should be administered with caution, as it can precipitate seizures in individuals who are physically dependent on benzodiazepines.

Benzodiazepines are a class of psychoactive drugs that have been widely used for their sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties. They act by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter in the central nervous system.

Benzodiazepines are commonly prescribed for the treatment of anxiety disorders, insomnia, seizures, and muscle spasms. They can also be used as premedication before medical procedures to produce sedation, amnesia, and anxiolysis. Some examples of benzodiazepines include diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and temazepam (Restoril).

While benzodiazepines are effective in treating various medical conditions, they can also cause physical dependence and withdrawal symptoms. Long-term use of benzodiazepines can lead to tolerance, meaning that higher doses are needed to achieve the same effect. Abrupt discontinuation of benzodiazepines can result in severe withdrawal symptoms, including seizures, hallucinations, and anxiety. Therefore, it is important to taper off benzodiazepines gradually under medical supervision.

Benzodiazepines are classified as Schedule IV controlled substances in the United States due to their potential for abuse and dependence. It is essential to use them only as directed by a healthcare provider and to be aware of their potential risks and benefits.

An adjuvant in anesthesia refers to a substance or drug that is added to an anesthetic medication to enhance its effects, make it last longer, or improve the overall quality of anesthesia. Adjuvants do not produce analgesia or anesthesia on their own but work synergistically with other anesthetics to achieve better clinical outcomes.

There are several types of adjuvants used in anesthesia, including:

1. Opioids: These are commonly used adjuvants that enhance the analgesic effect of anesthetic drugs. Examples include fentanyl, sufentanil, and remifentanil.
2. Alpha-2 agonists: Drugs like clonidine and dexmedetomidine are used as adjuvants to provide sedation, analgesia, and anxiolysis. They also help reduce the requirement for other anesthetic drugs, thus minimizing side effects.
3. Ketamine: This NMDA receptor antagonist is used as an adjuvant to provide analgesia and amnesia. It can be used in subanesthetic doses to improve the quality of analgesia during general anesthesia or as a sole anesthetic for procedural sedation.
4. Local anesthetics: When used as an adjuvant, local anesthetics can prolong the duration of postoperative analgesia and reduce the requirement for opioids. Examples include bupivacaine, ropivacaine, and lidocaine.
5. Neostigmine: This cholinesterase inhibitor is used as an adjuvant to reverse the neuromuscular blockade produced by non-depolarizing muscle relaxants at the end of surgery.
6. Dexamethasone: A corticosteroid used as an adjuvant to reduce postoperative nausea and vomiting, inflammation, and pain.
7. Magnesium sulfate: This non-competitive NMDA receptor antagonist is used as an adjuvant to provide analgesia, reduce opioid consumption, and provide neuroprotection in certain surgical settings.

The choice of adjuvants depends on the type of surgery, patient factors, and the desired clinical effects.

Cytochrome P-450 CYP3A is a subfamily of the cytochrome P-450 enzyme superfamily, which are primarily involved in drug metabolism in the human body. These enzymes are found predominantly in the liver, but also in other tissues such as the small intestine, kidneys, and brain.

CYP3A enzymes are responsible for metabolizing a wide variety of drugs, including many statins, benzodiazepines, antidepressants, and opioids. They can also metabolize endogenous compounds such as steroids and bile acids. The activity of CYP3A enzymes can be influenced by various factors, including genetic polymorphisms, age, sex, pregnancy, and the presence of other drugs or diseases.

The name "cytochrome P-450" refers to the fact that these enzymes contain a heme group that absorbs light at a wavelength of 450 nanometers when it is complexed with carbon monoxide. The term "CYP3A" denotes the specific subfamily of cytochrome P-450 enzymes that share a high degree of sequence similarity and function.

GABA (gamma-aminobutyric acid) modulators are substances that affect the function of GABA, which is the primary inhibitory neurotransmitter in the central nervous system. GABA plays a crucial role in regulating neuronal excitability and reducing the activity of overactive nerve cells.

GABA modulators can either enhance or decrease the activity of GABA receptors, depending on their specific mechanism of action. These substances can be classified into two main categories:

1. Positive allosteric modulators (PAMs): These compounds bind to a site on the GABA receptor that is distinct from the neurotransmitter binding site and enhance the activity of GABA at the receptor, leading to increased inhibitory signaling in the brain. Examples of positive allosteric modulators include benzodiazepines, barbiturates, and certain non-benzodiazepine drugs used for anxiolysis, sedation, and muscle relaxation.
2. Negative allosteric modulators (NAMs): These compounds bind to a site on the GABA receptor that reduces the activity of GABA at the receptor, leading to decreased inhibitory signaling in the brain. Examples of negative allosteric modulators include certain antiepileptic drugs and alcohol, which can reduce the effectiveness of GABA-mediated inhibition and contribute to their proconvulsant effects.

It is important to note that while GABA modulators can have therapeutic benefits in treating various neurological and psychiatric conditions, they can also carry risks for abuse, dependence, and adverse side effects, particularly when used at high doses or over extended periods.

Intravenous anesthetics are a type of medication that is administered directly into a vein to cause a loss of consciousness and provide analgesia (pain relief) during medical procedures. They work by depressing the central nervous system, inhibiting nerve impulse transmission and ultimately preventing the patient from feeling pain or discomfort during surgery or other invasive procedures.

There are several different types of intravenous anesthetics, each with its own specific properties and uses. Some common examples include propofol, etomidate, ketamine, and barbiturates. These drugs may be used alone or in combination with other medications to provide a safe and effective level of anesthesia for the patient.

The choice of intravenous anesthetic depends on several factors, including the patient's medical history, the type and duration of the procedure, and the desired depth and duration of anesthesia. Anesthesiologists must carefully consider these factors when selecting an appropriate medication regimen for each individual patient.

While intravenous anesthetics are generally safe and effective, they can have side effects and risks, such as respiratory depression, hypotension, and allergic reactions. Anesthesia providers must closely monitor patients during and after the administration of these medications to ensure their safety and well-being.

Dental anesthesia is a type of local or regional anesthesia that is specifically used in dental procedures to block the transmission of pain impulses from the teeth and surrounding tissues to the brain. The most common types of dental anesthesia include:

1. Local anesthesia: This involves the injection of a local anesthetic drug, such as lidocaine or prilocaine, into the gum tissue near the tooth that is being treated. This numbs the area and prevents the patient from feeling pain during the procedure.
2. Conscious sedation: This is a type of minimal sedation that is used to help patients relax during dental procedures. The patient remains conscious and can communicate with the dentist, but may not remember the details of the procedure. Common methods of conscious sedation include nitrous oxide (laughing gas) or oral sedatives.
3. Deep sedation or general anesthesia: This is rarely used in dental procedures, but may be necessary for patients who are extremely anxious or have special needs. It involves the administration of drugs that cause a state of unconsciousness and prevent the patient from feeling pain during the procedure.

Dental anesthesia is generally safe when administered by a qualified dentist or oral surgeon. However, as with any medical procedure, there are risks involved, including allergic reactions to the anesthetic drugs, nerve damage, and infection. Patients should discuss any concerns they have with their dentist before undergoing dental anesthesia.

Propofol is a short-acting medication that is primarily used for the induction and maintenance of general anesthesia during procedures such as surgery. It belongs to a class of drugs called hypnotics or sedatives, which work by depressing the central nervous system to produce a calming effect. Propofol can also be used for sedation in mechanically ventilated patients in intensive care units and for procedural sedation in various diagnostic and therapeutic procedures outside the operating room.

The medical definition of Propofol is:
A rapid-onset, short-duration intravenous anesthetic agent that produces a hypnotic effect and is used for induction and maintenance of general anesthesia, sedation in mechanically ventilated patients, and procedural sedation. It acts by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA) in the brain, leading to a decrease in neuronal activity and a reduction in consciousness. Propofol has a rapid clearance and distribution, allowing for quick recovery after discontinuation of its administration.

**Ketamine** is a dissociative anesthetic medication primarily used for starting and maintaining anesthesia. It can lead to a state of altered perception, hallucinations, sedation, and memory loss. Ketamine is also used as a pain reliever in patients with chronic pain conditions and during certain medical procedures due to its strong analgesic properties.

It is available as a generic drug and is also sold under various brand names, such as Ketalar, Ketanest, and Ketamine HCl. It can be administered intravenously, intramuscularly, orally, or as a nasal spray.

In addition to its medical uses, ketamine has been increasingly used off-label for the treatment of mood disorders like depression, anxiety, and post-traumatic stress disorder (PTSD), owing to its rapid antidepressant effects. However, more research is needed to fully understand its long-term benefits and risks in these applications.

It's important to note that ketamine can be abused recreationally due to its dissociative and hallucinogenic effects, which may lead to addiction and severe psychological distress. Therefore, it should only be used under the supervision of a medical professional.

Diazepam is a medication from the benzodiazepine class, which typically has calming, sedative, muscle relaxant, and anticonvulsant properties. Its medical uses include the treatment of anxiety disorders, alcohol withdrawal syndrome, end-of-life sedation, seizures, muscle spasms, and as a premedication for medical procedures. Diazepam is available in various forms, such as tablets, oral solution, rectal gel, and injectable solutions. It works by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which results in the modulation of nerve impulses in the brain, producing a sedative effect.

It is important to note that diazepam can be habit-forming and has several potential side effects, including drowsiness, dizziness, weakness, and impaired coordination. It should only be used under the supervision of a healthcare professional and according to the prescribed dosage to minimize the risk of adverse effects and dependence.

The anesthesia recovery period, also known as the post-anesthetic care unit (PACU) or recovery room stay, is the time immediately following anesthesia and surgery during which a patient's vital signs are closely monitored as they emerge from the effects of anesthesia.

During this period, the patient is typically observed for adequate ventilation, oxygenation, circulation, level of consciousness, pain control, and any potential complications. The length of stay in the recovery room can vary depending on the type of surgery, the anesthetic used, and the individual patient's needs.

The anesthesia recovery period is a critical time for ensuring patient safety and comfort as they transition from the surgical setting to full recovery. Nurses and other healthcare providers in the recovery room are specially trained to monitor and manage patients during this vulnerable period.

Buccal administration refers to the route of delivering a medication or drug through the buccal mucosa, which is the lining of the inner cheek in the mouth. This route allows for the medication to be absorbed directly into the bloodstream, bypassing the gastrointestinal tract and liver metabolism, which can result in faster onset of action and potentially higher bioavailability.

Buccal administration can be achieved through various forms of dosage forms such as lozenges, tablets, films, or sprays that are placed in contact with the buccal mucosa for a certain period of time until they dissolve or disintegrate and release the active ingredient. This route is commonly used for medications that require a rapid onset of action, have poor oral bioavailability, or are irritating to the gastrointestinal tract.

It's important to note that buccal administration may not be appropriate for all medications, as some drugs may be inactivated by saliva or may cause local irritation or discomfort. Therefore, it's essential to consult with a healthcare professional before using any medication through this route.

Fentanyl is a potent synthetic opioid analgesic, which is similar to morphine but is 50 to 100 times more potent. It is a schedule II prescription drug, typically used to treat patients with severe pain or to manage pain after surgery. It works by binding to the body's opioid receptors, which are found in the brain, spinal cord, and other areas of the body.

Fentanyl can be administered in several forms, including transdermal patches, lozenges, injectable solutions, and tablets that dissolve in the mouth. Illegally manufactured and distributed fentanyl has also become a major public health concern, as it is often mixed with other drugs such as heroin, cocaine, and counterfeit pills, leading to an increase in overdose deaths.

Like all opioids, fentanyl carries a risk of dependence, addiction, and overdose, especially when used outside of medical supervision or in combination with other central nervous system depressants such as alcohol or benzodiazepines. It is important to use fentanyl only as directed by a healthcare provider and to be aware of the potential risks associated with its use.

A drug interaction is the effect of combining two or more drugs, or a drug and another substance (such as food or alcohol), which can alter the effectiveness or side effects of one or both of the substances. These interactions can be categorized as follows:

1. Pharmacodynamic interactions: These occur when two or more drugs act on the same target organ or receptor, leading to an additive, synergistic, or antagonistic effect. For example, taking a sedative and an antihistamine together can result in increased drowsiness due to their combined depressant effects on the central nervous system.
2. Pharmacokinetic interactions: These occur when one drug affects the absorption, distribution, metabolism, or excretion of another drug. For example, taking certain antibiotics with grapefruit juice can increase the concentration of the antibiotic in the bloodstream, leading to potential toxicity.
3. Food-drug interactions: Some drugs may interact with specific foods, affecting their absorption, metabolism, or excretion. An example is the interaction between warfarin (a blood thinner) and green leafy vegetables, which can increase the risk of bleeding due to enhanced vitamin K absorption from the vegetables.
4. Drug-herb interactions: Some herbal supplements may interact with medications, leading to altered drug levels or increased side effects. For instance, St. John's Wort can decrease the effectiveness of certain antidepressants and oral contraceptives by inducing their metabolism.
5. Drug-alcohol interactions: Alcohol can interact with various medications, causing additive sedative effects, impaired judgment, or increased risk of liver damage. For example, combining alcohol with benzodiazepines or opioids can lead to dangerous levels of sedation and respiratory depression.

It is essential for healthcare providers and patients to be aware of potential drug interactions to minimize adverse effects and optimize treatment outcomes.

Hydroxyzine is an antihistamine medication that is primarily used to treat symptoms of allergies such as itching, hives, and swelling. It works by blocking the effects of histamine, a substance in the body that causes allergic reactions. In addition to its antihistaminic properties, hydroxyzine also has sedative and anxiety-reducing effects, which make it useful in treating anxiety disorders, symptoms of alcohol withdrawal, and as a sleep aid. It is available in both oral and injectable forms and is usually taken orally in the form of tablets, capsules, or syrup. As with any medication, hydroxyzine should be used under the supervision of a healthcare provider, and its use may be subject to certain precautions and contraindications depending on the individual's medical history and current health status.

Oxazepam is a benzodiazepine medication that is primarily used to treat anxiety disorders and symptoms such as sleeplessness and irritability. It works by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits the activity of certain neurons in the brain, producing a calming effect.

In medical terms, oxazepam can be defined as follows:

Oxazepam is a Schedule IV controlled substance, indicating that it has a potential for abuse and dependence. It is available in tablet form and is typically taken two to four times per day. Common side effects of oxazepam include drowsiness, dizziness, and weakness. More serious side effects can include memory problems, confusion, and difficulty breathing.

It's important to note that oxazepam should only be used under the supervision of a healthcare provider, as it can have significant risks and interactions with other medications. It is not recommended for use in pregnant women or those with a history of substance abuse.

Combined anesthetics refer to the use of two or more types of anesthetic agents together during a medical procedure to produce a desired level of sedation, amnesia, analgesia, and muscle relaxation. This approach can allow for lower doses of individual anesthetic drugs, which may reduce the risk of adverse effects associated with each drug. Common combinations include using a general anesthetic in combination with a regional or local anesthetic technique. The specific choice of combined anesthetics depends on various factors such as the type and duration of the procedure, patient characteristics, and the desired outcomes.

Deep sedation, also known as general anesthesia, is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. It is characterized by the loss of protective reflexes such as cough and gag, and the ability to ventilate spontaneously may be impaired. Patients may require assistance in maintaining a patent airway, and positive pressure ventilation may be required.

Deep sedation/general anesthesia is typically used for surgical procedures or other medical interventions that require patients to be completely unaware and immobile, and it is administered by trained anesthesia professionals who monitor and manage the patient's vital signs and level of consciousness throughout the procedure.

Premedication is the administration of medication before a medical procedure or surgery to prevent or manage pain, reduce anxiety, minimize side effects of anesthesia, or treat existing medical conditions. The goal of premedication is to improve the safety and outcomes of the medical procedure by preparing the patient's body in advance. Common examples of premedication include administering antibiotics before surgery to prevent infection, giving sedatives to help patients relax before a procedure, or providing medication to control acid reflux during surgery.

Dexmedetomidine is a medication that belongs to a class of drugs called alpha-2 adrenergic agonists. It is used for sedation and analgesia (pain relief) in critically ill patients, as well as for procedural sedation in adults and children. Dexmedetomidine works by mimicking the effects of natural chemicals in the body that help to regulate sleep, wakefulness, and pain perception.

The medical definition of dexmedetomidine is: "A selective alpha-2 adrenergic agonist used for sedation and analgesia in critically ill patients, as well as for procedural sedation in adults and children. Dexmedetomidine has sedative, anxiolytic, analgesic, and sympatholytic properties, and its effects are mediated by activation of alpha-2 adrenergic receptors in the central nervous system."

It is important to note that dexmedetomidine should only be administered under the close supervision of a healthcare professional, as it can have significant effects on heart rate, blood pressure, and respiratory function.

Thiopental, also known as Thiopentone, is a rapid-onset, ultrashort-acting barbiturate derivative. It is primarily used for the induction of anesthesia due to its ability to cause unconsciousness quickly and its short duration of action. Thiopental can also be used for sedation in critically ill patients, though this use has become less common due to the development of safer alternatives.

The drug works by enhancing the inhibitory effects of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain that produces a calming effect. This results in the depression of the central nervous system, leading to sedation, hypnosis, and ultimately, anesthesia.

It is worth noting that Thiopental has been largely replaced by newer drugs in many clinical settings due to its potential for serious adverse effects, such as cardiovascular and respiratory depression, as well as the risk of anaphylaxis. Additionally, it has been used in controversial procedures like capital punishment in some jurisdictions.

Alfentanil is a synthetic opioid analgesic drug that is chemically related to fentanyl. It is used for the provision of sedation and pain relief, particularly in critical care settings and during surgical procedures.

The medical definition of Alfentanil is as follows:

Alfentanil is a potent, short-acting opioid analgesic with a rapid onset of action. It is approximately 10 times more potent than morphine and has a rapid clearance rate due to its short elimination half-life of 1-2 hours. Alfentanil is used for the induction and maintenance of anesthesia, as well as for sedation and pain relief in critically ill patients. It works by binding to opioid receptors in the brain and spinal cord, which inhibits the transmission of pain signals and produces analgesia, sedation, and respiratory depression.

Like all opioids, Alfentanil carries a risk of dependence, tolerance, and respiratory depression, and should be used with caution in patients with respiratory or cardiovascular disease. It is typically administered by healthcare professionals in a controlled setting due to its potency and potential for adverse effects.

Intravenous injections are a type of medical procedure where medication or fluids are administered directly into a vein using a needle and syringe. This route of administration is also known as an IV injection. The solution injected enters the patient's bloodstream immediately, allowing for rapid absorption and onset of action. Intravenous injections are commonly used to provide quick relief from symptoms, deliver medications that are not easily absorbed by other routes, or administer fluids and electrolytes in cases of dehydration or severe illness. It is important that intravenous injections are performed using aseptic technique to minimize the risk of infection.

Intravenous anesthesia, also known as IV anesthesia, is a type of anesthesia that involves the administration of one or more drugs into a patient's vein to achieve a state of unconsciousness and analgesia (pain relief) during medical procedures. The drugs used in intravenous anesthesia can include sedatives, hypnotics, analgesics, and muscle relaxants, which are carefully selected and dosed based on the patient's medical history, physical status, and the type and duration of the procedure.

The administration of IV anesthesia is typically performed by a trained anesthesiologist or nurse anesthetist, who monitors the patient's vital signs and adjusts the dosage of the drugs as needed to ensure the patient's safety and comfort throughout the procedure. The onset of action for IV anesthesia is relatively rapid, usually within minutes, and the depth and duration of anesthesia can be easily titrated to meet the needs of the individual patient.

Compared to general anesthesia, which involves the administration of inhaled gases or vapors to achieve a state of unconsciousness, intravenous anesthesia is associated with fewer adverse effects on respiratory and cardiovascular function, and may be preferred for certain types of procedures or patients. However, like all forms of anesthesia, IV anesthesia carries risks and potential complications, including allergic reactions, infection, bleeding, and respiratory depression, and requires careful monitoring and management by trained medical professionals.

Dissociative anesthetics are a class of drugs that produce a state of altered consciousness, characterized by a sense of detachment or dissociation from the environment and oneself. These drugs work by disrupting the normal communication between the brain's thalamus and cortex, which can lead to changes in perception, thinking, and emotion.

Some examples of dissociative anesthetics include ketamine, phencyclidine (PCP), and dextromethorphan (DXM). These drugs can produce a range of effects, including sedation, analgesia, amnesia, and hallucinations. At high doses, they can cause profound dissociative states, in which individuals may feel as though they are outside their own bodies or that the world around them is not real.

Dissociative anesthetics are used medically for a variety of purposes, including as general anesthetics during surgery, as sedatives for diagnostic procedures, and as treatments for chronic pain and depression. However, they also have a high potential for abuse and can produce significant negative health effects when taken recreationally.

Oxidoreductases are a class of enzymes that catalyze oxidation-reduction reactions, where a electron is transferred from one molecule to another. N-Demethylating oxidoreductases are a specific subclass of these enzymes that catalyze the removal of a methyl group (-CH3) from a nitrogen atom (-N) in a molecule, which is typically a xenobiotic compound (a foreign chemical substance found within an living organism). This process often involves the transfer of electrons and the formation of water as a byproduct.

The reaction catalyzed by N-demethylating oxidoreductases can be represented as follows:
R-N-CH3 + O2 + H2O → R-N-H + CH3OH + H2O2

where R represents the rest of the molecule. The removal of the methyl group is often an important step in the metabolism and detoxification of xenobiotic compounds, as it can make them more water soluble and facilitate their excretion from the body.

The double-blind method is a study design commonly used in research, including clinical trials, to minimize bias and ensure the objectivity of results. In this approach, both the participants and the researchers are unaware of which group the participants are assigned to, whether it be the experimental group or the control group. This means that neither the participants nor the researchers know who is receiving a particular treatment or placebo, thus reducing the potential for bias in the evaluation of outcomes. The assignment of participants to groups is typically done by a third party not involved in the study, and the codes are only revealed after all data have been collected and analyzed.

Anesthetics are medications that are used to block or reduce feelings of pain and sensation, either locally in a specific area of the body or generally throughout the body. They work by depressing the nervous system, interrupting the communication between nerves and the brain. Anesthetics can be administered through various routes such as injection, inhalation, or topical application, depending on the type and the desired effect. There are several classes of anesthetics, including:

1. Local anesthetics: These numb a specific area of the body and are commonly used during minor surgical procedures, dental work, or to relieve pain from injuries. Examples include lidocaine, prilocaine, and bupivacaine.
2. Regional anesthetics: These block nerve impulses in a larger area of the body, such as an arm or leg, and can be used for more extensive surgical procedures. They are often administered through a catheter to provide continuous pain relief over a longer period. Examples include spinal anesthesia, epidural anesthesia, and peripheral nerve blocks.
3. General anesthetics: These cause a state of unconsciousness and are used for major surgical procedures or when the patient needs to be completely immobile during a procedure. They can be administered through inhalation or injection and affect the entire body. Examples include propofol, sevoflurane, and isoflurane.

Anesthetics are typically safe when used appropriately and under medical supervision. However, they can have side effects such as drowsiness, nausea, and respiratory depression. Proper dosing and monitoring by a healthcare professional are essential to minimize the risks associated with anesthesia.

Triazolam is a short-acting benzodiazepine drug, which is primarily used for the treatment of insomnia. It works by increasing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits the activity of neurons in the brain, thereby producing a calming effect. Triazolam has a rapid onset of action and its effects typically last for 1-2 hours, making it useful for inducing sleep. However, due to its short duration of action and potential for dependence and tolerance, triazolam is generally recommended for short-term use only.

Like all benzodiazepines, triazolam carries a risk of serious side effects, including respiratory depression, physical dependence, and cognitive impairment. It should be used with caution and under the close supervision of a healthcare provider.

The Cytochrome P-450 (CYP450) enzyme system is a group of enzymes found primarily in the liver, but also in other organs such as the intestines, lungs, and skin. These enzymes play a crucial role in the metabolism and biotransformation of various substances, including drugs, environmental toxins, and endogenous compounds like hormones and fatty acids.

The name "Cytochrome P-450" refers to the unique property of these enzymes to bind to carbon monoxide (CO) and form a complex that absorbs light at a wavelength of 450 nm, which can be detected spectrophotometrically.

The CYP450 enzyme system is involved in Phase I metabolism of xenobiotics, where it catalyzes oxidation reactions such as hydroxylation, dealkylation, and epoxidation. These reactions introduce functional groups into the substrate molecule, which can then undergo further modifications by other enzymes during Phase II metabolism.

There are several families and subfamilies of CYP450 enzymes, each with distinct substrate specificities and functions. Some of the most important CYP450 enzymes include:

1. CYP3A4: This is the most abundant CYP450 enzyme in the human liver and is involved in the metabolism of approximately 50% of all drugs. It also metabolizes various endogenous compounds like steroids, bile acids, and vitamin D.
2. CYP2D6: This enzyme is responsible for the metabolism of many psychotropic drugs, including antidepressants, antipsychotics, and beta-blockers. It also metabolizes some endogenous compounds like dopamine and serotonin.
3. CYP2C9: This enzyme plays a significant role in the metabolism of warfarin, phenytoin, and nonsteroidal anti-inflammatory drugs (NSAIDs).
4. CYP2C19: This enzyme is involved in the metabolism of proton pump inhibitors, antidepressants, and clopidogrel.
5. CYP2E1: This enzyme metabolizes various xenobiotics like alcohol, acetaminophen, and carbon tetrachloride, as well as some endogenous compounds like fatty acids and prostaglandins.

Genetic polymorphisms in CYP450 enzymes can significantly affect drug metabolism and response, leading to interindividual variability in drug efficacy and toxicity. Understanding the role of CYP450 enzymes in drug metabolism is crucial for optimizing pharmacotherapy and minimizing adverse effects.

Dental anxiety is a common feeling of fear or apprehension associated with dental appointments, treatments, or procedures. It can range from mild feelings of unease to severe phobias that cause people to avoid dental care altogether. Dental anxiety may stem from various factors such as negative past experiences, fear of pain, needles, or loss of control. In some cases, dental anxiety may lead to physical symptoms like sweating, rapid heartbeat, and difficulty breathing. It is important for individuals with dental anxiety to communicate their feelings with their dentist so that they can receive appropriate care and support.

Lorazepam is a medication that belongs to a class of drugs known as benzodiazepines. Medically, it is defined as a prescription drug used for the treatment of anxiety disorders, short-term relief of symptoms of anxiety or anxiety associated with depressive symptoms. It can also be used for the treatment of insomnia, seizure disorders, and alcohol withdrawal. Lorazepam works by affecting chemicals in the brain that may become unbalanced and cause anxiety or other symptoms.

It is important to note that lorazepam can be habit-forming and should only be used under the supervision of a healthcare provider. Misuse of this medication can lead to serious risks, including addiction, overdose, or death.

Intranasal administration refers to the delivery of medication or other substances through the nasal passages and into the nasal cavity. This route of administration can be used for systemic absorption of drugs or for localized effects in the nasal area.

When a medication is administered intranasally, it is typically sprayed or dropped into the nostril, where it is absorbed by the mucous membranes lining the nasal cavity. The medication can then pass into the bloodstream and be distributed throughout the body for systemic effects. Intranasal administration can also result in direct absorption of the medication into the local tissues of the nasal cavity, which can be useful for treating conditions such as allergies, migraines, or pain in the nasal area.

Intranasal administration has several advantages over other routes of administration. It is non-invasive and does not require needles or injections, making it a more comfortable option for many people. Additionally, intranasal administration can result in faster onset of action than oral administration, as the medication bypasses the digestive system and is absorbed directly into the bloodstream. However, there are also some limitations to this route of administration, including potential issues with dosing accuracy and patient tolerance.

"Administration, Rectal" is a medical term that refers to the process of administering medication or other substances through the rectum. This route of administration is also known as "rectal suppository" or "suppository administration."

In this method, a solid dosage form called a suppository is inserted into the rectum using fingers or a special applicator. Once inside, the suppository melts or dissolves due to the body's temperature and releases the active drug or substance, which then gets absorbed into the bloodstream through the walls of the rectum.

Rectal administration is an alternative route of administration for people who have difficulty swallowing pills or liquids, or when rapid absorption of the medication is necessary. It can also be used to administer medications that are not well absorbed through other routes, such as the gastrointestinal tract. However, it may take longer for the medication to reach the bloodstream compared to intravenous (IV) administration.

Common examples of rectally administered medications include laxatives, antidiarrheal agents, analgesics, and some forms of hormonal therapy. It is important to follow the instructions provided by a healthcare professional when administering medication rectally, as improper administration can reduce the effectiveness of the medication or cause irritation or discomfort.

Hydroxylation is a biochemical process that involves the addition of a hydroxyl group (-OH) to a molecule, typically a steroid or xenobiotic compound. This process is primarily catalyzed by enzymes called hydroxylases, which are found in various tissues throughout the body.

In the context of medicine and biochemistry, hydroxylation can have several important functions:

1. Drug metabolism: Hydroxylation is a common way that the liver metabolizes drugs and other xenobiotic compounds. By adding a hydroxyl group to a drug molecule, it becomes more polar and water-soluble, which facilitates its excretion from the body.
2. Steroid hormone biosynthesis: Hydroxylation is an essential step in the biosynthesis of many steroid hormones, including cortisol, aldosterone, and the sex hormones estrogen and testosterone. These hormones are synthesized from cholesterol through a series of enzymatic reactions that involve hydroxylation at various steps.
3. Vitamin D activation: Hydroxylation is also necessary for the activation of vitamin D in the body. In order to become biologically active, vitamin D must undergo two successive hydroxylations, first in the liver and then in the kidneys.
4. Toxin degradation: Some toxic compounds can be rendered less harmful through hydroxylation. For example, phenol, a toxic compound found in cigarette smoke and some industrial chemicals, can be converted to a less toxic form through hydroxylation by enzymes in the liver.

Overall, hydroxylation is an important biochemical process that plays a critical role in various physiological functions, including drug metabolism, hormone biosynthesis, and toxin degradation.

Etomidate is a intravenous anesthetic medication used for the induction of general anesthesia. It provides a rapid and smooth induction with minimal cardiovascular effects, making it a popular choice in patients with hemodynamic instability. Etomidate also has antiseizure properties. However, its use is associated with adrenal suppression, which can lead to complications such as hypotension and impaired stress response. Therefore, its use is generally avoided in critically ill or septic patients.

The medical definition of 'Etomidate' is:

A carboxylated imidazole derivative that is used as an intravenous anesthetic for the induction of general anesthesia. It has a rapid onset of action and minimal cardiovascular effects, making it useful in patients with hemodynamic instability. Etomidate also has antiseizure properties. However, its use is associated with adrenal suppression, which can lead to complications such as hypotension and impaired stress response. Therefore, its use is generally avoided in critically ill or septic patients.

In the context of pharmacology, "half-life" refers to the time it takes for the concentration or amount of a drug in the body to be reduced by half during its elimination phase. This is typically influenced by factors such as metabolism and excretion rates of the drug. It's a key factor in determining dosage intervals and therapeutic effectiveness of medications, as well as potential side effects or toxicity risks.

... the active metabolite of midazolam is minor and contributes to only 10 percent of biological activity of midazolam. Midazolam ... In the Netherlands, midazolam is a List II drug of the Opium Law. Midazolam is a Schedule IV drug under the Convention on ... Oxidation of midazolam is the major metabolite in human liver microsome (HLM). The half life (T1/2) of midazolam in HLM is 3.3 ... Prolonged infusions with midazolam results in the development of tolerance; if midazolam is given for a few days or more a ...
Shaban AA (2016). "Effect of small dose propofol or midazolam to prevent laryngospasm and coughing following oropharyngeal ... Reves JG, Fragen R, Vinik R, Greenblatt D (1985). "Midazolam". Anesthesiology. 62 (3): 310-324. doi:10.1097/00000542-198503000- ... lidocaine and midazolam are adjuvant agents frequently administered to minimize pain during the injection of the induction ...
Midazolam - Apart as a premedication, midazolam can be used as an induction agent at the dose of 0.2 to 0.3 mg/kg. It has slow ... Midazolam is metabolized in the liver and is excreted through the kidneys. When midazolam is used alone, it has few side ... Usual doses for midazolam are 1 mg to 2 mg where the older people receive smaller doses and obese people receive higher doses. ... Midazolam - It is a fast-acting and the most lipophilic of all benzodiazepine and rapidly crosses the blood-brain barrier. It ...
Midazolam is the most commonly prescribed for this use because of its strong sedative actions and fast recovery time, as well ... Examples are brotizolam, midazolam, and triazolam. Intermediate-acting compounds have a median half-life of 12-40 hours. They ... "Midazolam Injection" (PDF). Medsafe. New Zealand Ministry of Health. 2012-10-26. Archived from the original (PDF) on 2016-02-22 ... In the community, intravenous administration is not practical and so rectal diazepam or buccal midazolam are used, with a ...
Although midazolam is not recommended or approved by the Food and Drug Administration as an anesthetic, the Court explained ... Evans' testimony that midazolam could "paralyze the brain" was directly refuted by peer-reviewed articles cited by the ... The petitioners argued that the midazolam, intended to be used as sedative, would not render them unable to feel the pain of ... Sotomayor stated that "under the Court's new rule, it would not matter whether the State intended to use midazolam, or instead ...
... is sometimes used as an alternative to midazolam in palliative sedation. In intensive care units lorazepam is ... Olkkola KT, Ahonen J (2008). "Midazolam and other benzodiazepines". Modern Anesthetics. Handbook of Experimental Pharmacology. ...
Examples include midazolam and ciclosporin. Interactions via other enzymes have only been studied in vitro. According to these ...
"Midazolam has no analgesic properties. It's a whole different drug class than sodium thiopental or barbiturates," Stevens said ... While Florida had previously used the same three drugs in a 2013 execution, they used 500 mg of midazolam rather than the 100 ... The execution began at 6:23 p.m. CDT, when the first drug midazolam (sedative), was administered. After Lockett was declared ... Instead of sedating some patients, midazolam can make them violent. Dennis McGuire took 25 minutes to die; he gasped and ...
Diazepam and midazolam are alternatives. This may be repeated if there is no effect after 10 minutes. If there is no effect ...
Kurz A, Sessler DI, Annadata R, Dechert M, Christensen R (1995). "Midazolam minimally impairs thermoregulatory control". Anesth ...
Van Hook was executed via lethal injection using a combination of three drugs; midazolam, rocuronium bromide and potassium ...
Moon YE (July 2013). "Paradoxical reaction to midazolam in children". Korean Journal of Anesthesiology. 65 (1): 2-3. doi: ...
... replaces midazolam as the sedative. Drug companies have made it harder to buy midazolam for executions. The etomidate ... Di Liddo L, D'Angelo A, Nguyen B, Bailey B, Amre D, Stanciu C (October 2006). "Etomidate versus midazolam for procedural ...
Included drugs are Benzodiazepines (Subclass CD Benz), other than temazepam, flunitrazepam or midazolam, and androgenic and ... Neither phenobarbitone nor midazolam require safe custody. Other Sch 3 drugs can be stored in the general dispensary. ...
... and midazolam; his death was caused by a propofol overdose. News of his death spread quickly online, causing websites to slow ...
Doenicke A, Kugler J, Mayer M, Angster R, Hoffmann P (October 1992). "[Ketamine racemate or S-(+)-ketamine and midazolam. The ... 0.8 for midazolam (active placebo), and Cohen's d = 0.53-0.81 for conventional antidepressants). However, the efficacy of ... midazolam, d = 0.8). These figures, though preliminary, contrast with the average effect size of conventional antidepressants ( ...
Midazolam): a coronary dilator. In midazolam's presence, dilation was unaffected by N-nitro L-arginine, indomethacin and ... dose dependently attenuated the vasodilating effect of midazolam Estrogen has been shown to abolish abnormal cold-induced ...
"Automated gas chromatography for studies of midazolam pharmacokinetics". Anesthesiology. 55 (2): 176-9. doi:10.1097/00000542- ...
Propofol and midazolam are equally effective as sedatives. Hypertonic saline can improve ICP by reducing the amount of cerebral ...
Midazolam the shortest half-life of any available drugs. It is ideal for short appointments and simple procedures. It has many ...
Yutrzenka GJ, Patrick GA, Rosenberger W (July 1989). "Substitution of temazepam and midazolam in pentobarbital-dependent rats ... "Efficacy without tolerance or rebound insomnia for midazolam and temazepam after use for one to three months". Journal of ...
Dhir A, Rogawski MA (April 2012). "Role of neurosteroids in the anticonvulsant activity of midazolam". British Journal of ...
Lawn, John (March 25, 1986). "Schedules of Controlled Substances; Placement of Quazepam and Midazolam into Schedule IV" (PDF). ...
Bronson ME (Jun-Jul 1995). "Chronic bretazenil produces tolerance to chlordiazepoxide, midazolam, and abecarnil". Pharmacology ...
Dormicum (midazolam), for insomnia and procedural sedation and analgesia. Erivedge (vismodegib), for basal-cell carcinoma. ... Versed (midazolam), for insomnia and procedural sedation and analgesia. Vesanoid (tretinoin), for acute promyelocytic leukaemia ...
It is activated by certain benzodiazepines such as diazepam and midazolam, and via this action, inhibitory neurosteroid levels ... Dhir A, Rogawski MA (Apr 2012). "Role of neurosteroids in the anticonvulsant activity of midazolam". British Journal of ...
Examples of these drugs include Triazolam, Midazolam and Diazepam. There is a growing amount of information that has shown that ...
Hong W, Short TG, Hui TW (December 1993). "Hypnotic and anesthetic interactions between ketamine and midazolam in female ... Ketamine potentiates the sedative effects of propofol and midazolam. Naltrexone potentiates psychotomimetic effects of a low ...
Many benzodiazepines (including midazolam) have longer half-lives than flumazenil. Therefore, in cases of overdose, repeated ... ISBN 978-0-07-141640-5. Kawano DF, Ueta J, Sankarankutty AK, Pereira LR, de Freitas O (June 2009). "Midazolam-related drug ...
PMID 15318476 [1] Baykara N, Sahin T, Toker K. The effect of midazolam-thiopental coinduction on recovery in minor surgery. J ... A standard coinduction regimen for an adult might consist of a benzodiazepine sedative amnesic such as midazolam, followed by ... The effect of coinduction with midazolam on propofol injection pain. Eur J Anaesthesiol. 2004 Jul;21(7):579-81. ... PMID 10858838 [3] Anderson L, Robb H. Propofol/midazolam coinduction. Anasthesiol Intensivmed Notfallmed Schmerzther. ...
... the active metabolite of midazolam is minor and contributes to only 10 percent of biological activity of midazolam. Midazolam ... In the Netherlands, midazolam is a List II drug of the Opium Law. Midazolam is a Schedule IV drug under the Convention on ... Oxidation of midazolam is the major metabolite in human liver microsome (HLM). The half life (T1/2) of midazolam in HLM is 3.3 ... Prolonged infusions with midazolam results in the development of tolerance; if midazolam is given for a few days or more a ...
Midazolam Injection: learn about side effects, dosage, special precautions, and more on MedlinePlus ... Before receiving midazolam injection,. *tell your doctor and pharmacist if you are allergic to midazolam or any other ... Midazolam injection comes as a solution (liquid) to be injected into a muscle or vein by a doctor or nurse in a hospital or ... If you receive midazolam injection in the ICU over a long period of time, your body may become dependent on it. Your doctor ...
Nayzilam (midazolam) is a benzodiazepine. The exact mechanism of action for midazolam is not fully understood, but it is ... Nayzilam (midazolam) is a benzodiazepine.. Nayzilam is specifically indicated for the acute treatment of intermittent, ...
... Injection contains midazolam a Schedule IV substance.. Midazolam was actively self-administered in primate models ... MIDAZOLAM HYDROCHLORIDE (UNII: W7TTW573JJ) (MIDAZOLAM - UNII:R60L0SM5BC) MIDAZOLAM. 5 mg in 1 mL. ... Midazolam was administered as an infusion (5 to 15 mg/hours). Midazolam clearance was reduced (1.9 vs 2.8 mL/min/kg) and the ... Midazolam is a short-acting benzodiazepine central nervous system (CNS) depressant.. The effects of midazolam on the CNS are ...
Midazolam is used to produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures. Midazolam is ... Midazolam is a benzodiazepine. Benzodiazepines belong to the group of medicines called central nervous system (CNS) depressants ...
After removal of the diseased liver, five subjects received 2 mg midazolam intraduodenally, and the other five received … ... The in vivo intestinal metabolism of the CYP3A probe midazolam to its principal metabolite, 1-hydroxymidazolam, was ... A mass balance approach that considered the net change in midazolam (intravenously) or midazolam and 1-hydroxymidazolam ( ... First-pass metabolism of midazolam by the human intestine Clin Pharmacol Ther. 1996 Jul;60(1):14-24. doi: 10.1016/S0009-9236(96 ...
Midazolam Nasal Spray Midazolam nasal spray is used for emergency situations to stop cluster seizures (episodes of increased ... Midazolam Midazolam is given to children before medical procedures or before anesthesia for surgery to cause drowsiness, ... Midazolam Injection Midazolam injection is used before medical procedures and surgery to cause drowsiness, relieve anxiety, and ... with this combination.Talk with your health provider.Midazolam (Versed)The body breaks down midazolam to get rid of it. Yerba ...
Midazolam hydrochloride contains midazolam, a Schedule IV control substance. Midazolam was actively self-administered in ... midazolam hydrochloride (UNII: W7TTW573JJ) (midazolam - UNII:R60L0SM5BC) midazolam. 2 mg in 2 mL. ... Midazolam was administered as an infusion (5 to 15 mg/hr). Midazolam clearance was reduced (1.9 vs 2.8 mL/min/kg) and the half- ... Midazolam is a white or yellowish crystalline powder, insoluble in water. The hydrochloride salt of midazolam, which is formed ...
Bioaccumulation. Midazolam has high potential for bioaccumulation.. Toxicity. It cannot be excluded that midazolam is toxic, ... Midazolam PECsurfacewater value is below the action limit of 0.01μg/L and is not a PBT substance as log KOW does not exceed 4.5 ... Bioaccumulation: Log P = 4.33 at physiological (estimated by unknown method). Since log P ≥ 4 at 7, midazolam has high ... Risk. Risk of environmental impact of midazolam cannot be excluded, since no ecotoxicity data are available. ...
Rescue therapy with a second midazolam dose was required in 282 (18%) patients. Higher midazolam doses were associated with ... Prehospital midazolam use and outcomes among patients with out-of-hospital status epilepticus. Elan L. Guterman, Joseph K. ... Author response: Prehospital midazolam use and outcomes among patients with out-of-hospital status epilepticus *Elan L. ... Reader response: Prehospital midazolam use and outcomes among patients with out-of-hospital status epilepticus *Christoph ...
Oxidation of midazolam and triazolam by human liver cytochrome P450IIIA4.. T Kronbach, D Mathys, M Umeno, F J Gonzalez and U A ... Oxidation of midazolam and triazolam by human liver cytochrome P450IIIA4.. T Kronbach, D Mathys, M Umeno, F J Gonzalez and U A ... Oxidation of midazolam and triazolam by human liver cytochrome P450IIIA4.. T Kronbach, D Mathys, M Umeno, F J Gonzalez and U A ... Oxidation of midazolam and triazolam by human liver cytochrome P450IIIA4. Message Subject (Your Name) has forwarded a page to ...
Get up-to-date information on Midazolam side effects, uses, dosage, overdose, pregnancy, alcohol and more. Learn more about ... Midazolam can cause serious side effects (see "Midazolam Precautions").. These are not all the possible side effects of ... Product Information: midazolam hcl oral syrup, midazolam hcl oral syrup. Roxane Laboratories,Inc, Columbus, OH, 2007. Product ... Common side effects of midazolam include headache, nausea, and vomiting.. Midazolam can also cause dizziness and drowsiness. ...
Spinal anesthesia was administered to 20 patients, aged between 2 months and 2 years, premedicated with 0.5 mg/kg midazolam + 5 ... We found that rectal premedication with midazolam, ketamine and atropine increases tolerance to vein puncture and spinal ... designed to investigate the anxiolytic effects as well as acceptance of spinal anesthesia after rectally administered midazolam ... Spinal anesthesia was administered to 20 patients, aged between 2 months and 2 years, premedicated with 0.5 mg/kg midazolam + 5 ...
The Real First Wave - Midazolam - Hancock Must Be Jailed For Life - David Icke Dot-Connector. ...
The Effect of Midazolam and Dexmedetomidine Sedation on Block Characteristic Following Spinal Bupivacaine: A Randomized ... The Effect of Midazolam and Dexmedetomidine Sedation on Block Characteristic Following Spinal Bupivacaine: A Randomized ... The Effect of Midazolam and Dexmedetomidine Sedation on Block Characteristic Following Spinal Bupivacaine: A Randomized ...
Midazolam in flexible bronchoscopy premedication: effects on patient-related and procedure-related outcomes. ... Midazolam in flexible bronchoscopy premedication: effects on patient-related and procedure-related outcomes.. Author(s): ... RESULTS: A total of 100 patients (mean age 58.6±1.0; 57% male) were included in the study (33 in the low-dose midazolam group, ... BACKGROUND: The role of midazolam in flexible bronchoscopy premedication has been debated. The aim of the present study was to ...
Tannbehandling i tråd med «Fire gode vaner» kombinert med sedasjon med midazolam («Four Habits Model»/midazolam) ble vurdert ... Dentist-administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in ... Tannlegeadministrert kognitiv atferdsterapi versus «Fire gode vaner» - bruk av midazolam. En randomisert kontrollert studie av ... Tannbehandling under sedasjon med midazolam kombinert med bruk av kommunikasjonsmetoden «Fire gode vaner» kan effektivt ...
Concomitant Use of Midazolam and Buprenorphine and its Implications Among Drug Users in Singapore. Wei-Ling Ng, Subramaniam ... Midazolam was the most commonly used BZD. Buprenorphine abusers who were concomitantly using BZDs were significantly younger ...
Midazolam for urethral catheterisation in female infants with suspected urinary tract infection: a case-control study ... Midazolam for urethral catheterisation in female infants with suspected urinary tract infection: a case-control study ... One hundred and forty-one patients were treated with oral midazolam and 23 received the drug intranasally. Cases and controls ... Results Two cohorts of patients who underwent UC were compared, 164 female infants who were sedated with midazolam (case ...
... and mouth mucosa midazolam) or buccal midazolam).af. Search Outcome. Medline: 35 papers were identified, 4 were relevant to the ... mouth mucosa midazolam OR buccal midazolam]. Limited to Human AND English language (((((((Child or children or adolescence) and ... 6 mins for midazolam & 8 mins for diazepam (P=0.31). Comment(s). Emergency treatment for prolonged tonic-clonic seizures has ... Buccal Midazolam vs Rectal Diazepam: Which is more effective in the treatment of acute seizures in children in Accident and ...
Comparative study on the efficacy of intranasal midazolam versus intravenous midazolam and intravenous diazepam in convulsing ... COMPARATIVE STUDY ON THE EFFICACY OF INTRANASAL MIDAZOLAM VERSUS INTRAVENOUS MIDAZOLAM AND INTRAVENOUS DIAZEPAM IN CONVULSING ... We conducted this study to evaluate the efficacy of intranasal midazolam vs. intravenous midazolam and intravenous diazepam in ... Sharma R, Harish R. COMPARATIVE STUDY ON THE EFFICACY OF INTRANASAL MIDAZOLAM VERSUS INTRAVENOUS MIDAZOLAM AND INTRAVENOUS ...
DOES BUCCAL MIDAZOLAM (BM) OFFER A HIGH DEGREE OF SATISFACTION AMONGST PARENTS AND HEALTHCARE PROFESSIONALS IN MANAGING ... DOES BUCCAL MIDAZOLAM (BM) OFFER A HIGH DEGREE OF SATISFACTION AMONGST PARENTS AND HEALTHCARE PROFESSIONALS IN MANAGING ...
Argentina, Austria, Belgium, Colombia, Croatia, Denmark, Egypt, Finland, Germany, Greece, Hungary, Ireland, Mexico, Netherlands, Poland, Portugal, Republic of South Africa, Romania, Russian, Saudi Arabia, Slovenia, Spain, Sweden, Switzerland, Turkey, United Arab Emirates ...
Making Oral Midazolam Palatable for Children Mary D. Peterson, M.D. Mary D. Peterson, M.D. ... Mary D. Peterson; Making Oral Midazolam Palatable for Children. Anesthesiology 1990; 73:1053 doi: https://doi.org/10.1097/ ...
Buccal midazolam for the management of seizures. 5 October 2021 · SPS PGD template for administering buccal midazolam for the ...
Sedation with midazolam can be assumed to be an applicable, well-tolerated, safe method for IOP measurements in children. ... The effects of midazolam on intraocular pressure in children during examination under sedation ... Therefore, we investigated the effects of oral midazolam on IOP in children. Methods: In a prospective study, IOP was measured ... Therefore, we investigated the effects of oral midazolam on IOP in children.. Methods:. In a prospective study, IOP was ...
Nasal fentanyl and buccal midazolam carer administration as needed for breakthrough symptom control in a specialist ... Nasal fentanyl and buccal midazolam carer administration as needed for breakthrough symptom control in a specialist ... Nasal fentanyl and buccal midazolam carer administration as needed for breakthrough symptom control in a specialist ...
Revyuh reports on new science projects, new discoveries, health-related studies, forensics, crime, schools, policies, climate change, and a little bit about politics, business, entertainment, social media, lifestyle and sports. ...
  • Long-term use for the management of epilepsy is not recommended due to the significant risk of tolerance (which renders midazolam and other benzodiazepines ineffective) and the significant side effect of sedation. (wikipedia.org)
  • Midazolam is effective for status epilepticus or when intravenous access cannot be obtained, and has advantages of being water-soluble, having a rapid onset of action and not causing metabolic acidosis from the propylene glycol vehicle (which is not required due to its solubility in water), which occurs with other benzodiazepines. (wikipedia.org)
  • Midazolam is in a class of medications called benzodiazepines. (medlineplus.gov)
  • Midazolam is a member of a group of drugs known as benzodiazepines. (cureepilepsy.org)
  • If you are allergic to midazolam or any other benzodiazepines (alprazolam, diazepam, clonazepam, clobazam), or if you have a known sensitivity to polyethylene glycol, propylene glycol, or benzyl alcohol, then you should not take it. (cureepilepsy.org)
  • Sublingual benzodiazepines, including midazolam, are effective in humans. (vin.com)
  • Long-term use of epilepsy treatment is not advised as a significant side effect from sedation because of the significant possibility of resistance (which ineffectualizes midazolam and other benzodiazepines). (onlinepsychedelicstore.com)
  • Midazolam nasal spray is approved by the FDA because the benefits of arresting status epilepticus outweigh the risks. (cureepilepsy.org)
  • Further, as midazolam nasal spray is administered while directly under the care of a healthcare provider, adverse effects may more easily be managed. (cureepilepsy.org)
  • If you are administered midazolam nasal spray, your healthcare providers will watch you for symptoms such as weak or shallow breathing. (cureepilepsy.org)
  • Follow the steps below to see if you're eligible* for a NAYZILAM ® (midazolam) nasal spray, CIV, Patient Savings Card and to receive NAYZILAM support. (nayzilam.com)
  • These findings suggest that midazolam nasal spray could be an effective rescue treatment option for patients and caregivers who live with seizure clusters, subject to FDA review," president Bill Pullman said in prepared remarks. (drugdeliverybusiness.com)
  • We look forward to working with the FDA and submitting a New Drug Application for midazolam nasal spray later this year. (drugdeliverybusiness.com)
  • Given the challenges and unmet needs of those living with seizures, we are very encouraged by the results of the Phase III trial of midazolam nasal spray. (drugdeliverybusiness.com)
  • Buccal and intranasal midazolam may be both easier to administer and more effective than rectally administered diazepam in the emergency control of seizures. (wikipedia.org)
  • Proximagen Ltd. said today that its pivotal Phase III trial of intranasal midazolam met its primary efficacy endpoint as a treatment for patients with seizure clusters. (drugdeliverybusiness.com)
  • Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia and procedural sedation, and to treat severe agitation. (wikipedia.org)
  • Intravenous midazolam is indicated for procedural sedation (often in combination with an opioid, such as fentanyl), preoperative sedation, for the induction of general anesthesia, and for sedation of people who are ventilated in critical care units. (wikipedia.org)
  • However, for long-term sedation, lorazepam is preferred due to its long duration of action, and propofol has advantages over midazolam when used in the ICU for sedation, such as shorter weaning time and earlier tracheal extubation. (wikipedia.org)
  • Sedation using midazolam can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. (wikipedia.org)
  • At higher doses during the last weeks of life, midazolam is considered a first line agent in palliative continuous deep sedation therapy when it is necessary to alleviate intolerable suffering not responsive to other treatments, but the need for this is rare. (wikipedia.org)
  • Intravenous midazolam has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings. (nih.gov)
  • The initial pediatric dose of midazolam for sedation/anxiolysis/amnesia is age, procedure, and route dependent (see DOSAGE AND ADMINISTRATION for complete dosing information). (nih.gov)
  • Background: Drugs used for sedation/analgesia during gastrointestinal (GI) endoscopy, including midazolam, fentanyl, and propofol, result in short-term, reversible decline in cognitive function. (cogstate.com)
  • Midazolam is a benzodiazepine drug used for anesthesia, surgical sedation, sleeping disorders, and extreme agitation. (onlinepsychedelicstore.com)
  • Midazolam conscious sedation in 2-4 years old children Sedación consciente en pacientes de 2 a 4 años con Midazolam . (bvsalud.org)
  • Objective The purpose of this study was to assess anxiety in 2 to 4 year-old children, treated under conscious sedation with midazolam. (bvsalud.org)
  • Re-audit of the use of flumazenil following midazolam-induced conscious sedation. (bvsalud.org)
  • Flumazenil is an antagonist drug of Benzodiazepam (BDZ) that has been used as a reversal agent of midazolam -induced conscious sedation (CS) in both emergency and elective procedures . (bvsalud.org)
  • midazolam should not be used for longer than 72 hours due to risks of tachyphylaxis, and the possibility of development of a benzodiazepine withdrawal syndrome, as well as neurological complications. (wikipedia.org)
  • Midazolam hydrochloride injection is a water-soluble benzodiazepine available as a sterile, nonpyrogenic parenteral dosage form for intravenous or intramuscular injection. (nih.gov)
  • Chemically, midazolam HCl is 8-chloro-6(2-fluorophenyl)-1-methyl-4 H -imidazo[1,5-a][1,4]benzodiazepine hydrochoride. (nih.gov)
  • Midazolam is a short-acting benzodiazepine central nervous system (CNS) depressant. (nih.gov)
  • The present study has attempted to determine whether similar control exists in humans by using midazolam, a benzodiazepine. (portlandpress.com)
  • The benzodiazepine midazolam acts on the expressio. (fapesp.br)
  • Midazolam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen) that is used to help you relax before having a minor surgery, dental work, or other medical procedure. (astistrial.com)
  • Midazolam is superior to diazepam in impairing memory of endoscopy procedures, but propofol has a quicker recovery time and a better memory-impairing effect. (wikipedia.org)
  • Buccal midazolam is recommended by NICE 2 for the management of prolonged acute convulsive seizures, and is preferred by most patients and carers compared to the administration of rectal diazepam 3,4 . (acnr.co.uk)
  • Nakken K and Lossius M. Buccal midazolam or rectal diazepam for treatment of residential adult patients with serial seizures or status epilepticus. (acnr.co.uk)
  • This 3-hour training is for anyone who supports a child, young person or adult with epilepsy and may be required to administer buccal midazolam for prolonged seizures. (teachhealth.co.uk)
  • Training also includes the use of emergency medication for prolonged seizures (buccal midazolam) and sets out the principles and safety aspects that relate to administration. (teachhealth.co.uk)
  • Epilepsy & Buccal Midazolam Training for schools and colleges across Hertfordshire. (teachhealth.co.uk)
  • First Aid, Asthma and Anaphylaxis Awareness, Epilepsy Awareness, Buccal Midazolam and Mental Health Training Courses for teachers. (teachhealth.co.uk)
  • Experts in Epilepsy Awareness Training Courses, and Buccal Midazolam Training for School and College Teachers Staff. (teachhealth.co.uk)
  • [39] When midazolam is administered in combination with fentanyl, the incidence of hypoxemia or apnea becomes more likely. (combatmedicine101.com)
  • A benefit of midazolam is that in children it can be given in the cheek or in the nose for acute seizures, including status epilepticus. (wikipedia.org)
  • citation needed] Drawbacks include a high degree of breakthrough seizures-due to the short half-life of midazolam-in over 50% of people treated, as well as treatment failure in 14-18% of people with refractory status epilepticus. (wikipedia.org)
  • The benefit of intramuscular midazolam for status epilepticus demonstrated by the double-blind RAMPART study highlights the practical considerations of treating patients who are actively seizing. (medscape.com)
  • Because prompt treatment of status epilepticus strongly influences morbidity and mortality, it is likely that the results of this study will translate into US Food and Drug Administration approval of intramuscular midazolam for status epilepticus in the near future. (medscape.com)
  • As with all antiseizure medications, midazolam should be withdrawn gradually to minimize the risk of causing or worsening seizures or status epilepticus. (cureepilepsy.org)
  • As status epilepticus is a potentially life-threatening condition associated with a high risk of permanent neurological impairment, there may be occasions where the use of midazolam is required despite the risks of serious adverse events. (cureepilepsy.org)
  • Your child's doctor may decide not to give midazolam to your child if he or she is taking one or more of these medications. (medlineplus.gov)
  • Do not give midazolam to persons with known hypersensitivities to the drug. (ivsedationcertification.com)
  • In RAMPART, 893 persons who had convulsions lasting more than 5 minutes that were still ongoing when emergency medical personnel arrived were randomly assigned to receive either intramuscular midazolam plus intravenous placebo or intravenous lorazepam plus intramuscular placebo. (medscape.com)
  • Intramuscular midazolam was administered with an autoinjector. (medscape.com)
  • Median times to treatment were 4 times longer with intravenous lorazepam (4.8 minutes) vs intramuscular midazolam (1.2 minutes). (medscape.com)
  • Although lorazepam had a faster onset of action, the fact that intramuscular midazolam could be administered more quickly resulted in similar times to effectiveness for the 2 drugs. (medscape.com)
  • In pediatric patients, up to 85% had no recall of pictures shown after receiving intramuscular midazolam compared with 5% of the placebo controls. (nih.gov)
  • When I tried to have it filled they told me that the Midazolam (the generic version of Nayzilam ) spray doesn't exist, only some sort of vial. (coping-with-epilepsy.com)
  • Midazolam must never be used without individualization of dosage. (nih.gov)
  • Documents showing the dosage of Midazolam given to Covid patients and showing how breathlessness in patients is to be managed using Midazolam. (substack.com)
  • In this proof-of-concept randomized, double-blind, single-dose crossover clinical trial, 17 adolescents (ages 13-17) with a diagnosis of major depressive disorder received a single intravenous infusion of either ketamine (0.5 mg/kg over 40 minutes) or midazolam (0.045 mg/kg over 40 minutes), and the alternate compound 2 weeks later. (nih.gov)
  • A significantly greater proportion of participants experienced a response to ketamine during the first 3 days following infusion as compared with midazolam (76% and 35%, respectively). (nih.gov)
  • The current study compared acceptance of and behavioral responses to Transmucosal midazolam and Ketamine administered via the sublingual route in cat. (vin.com)
  • Ten mal mature free roaming cats received different doses of Ketamine (20, 40, 80, 120 mg/kg) Or midazolam (0.3, 0.6, 1.2, 2.4, 4.8 mg/kg) under the tongue with additional sugar. (vin.com)
  • Animals accepted midazolam and Ketamine administered via the sublingual. (vin.com)
  • Different doses of ketamine and midazolam showed dose dependent effect in CNS depression. (vin.com)
  • Also onset of effect in midazolam administration was dose dependent but in regard with ketamine wasn't in this order. (vin.com)
  • Sublingual administration of ketamine is effective as and better suppressed than sublingual midazolam as a sedative-hypnotic in cats. (vin.com)
  • The aim of this study was to compare the ability of ketamine (5 mg/kg) versus alfaxalone (5 mg/kg), in combination with dexmedetomidine (50 µg/kg) and midazolam (1 mg/kg) (KDM, ADM), to provide a loss of reflexes and safe orotracheal intubation without producing apnea in American alligators ( Alligator mississippiensis ). (allenpress.com)
  • Midazolam can be given by mouth, intravenously, by injection into a muscle, by spraying into the nose, or through the cheek. (wikipedia.org)
  • 3. Doses of 1 ;mg and 5 ;mg of midazolam were administered intravenously. (portlandpress.com)
  • In the final stages of end-of-life care, midazolam is routinely used at low doses via subcutaneous injection to help with agitation, restlessness or anxiety in the last hours or days of life. (wikipedia.org)
  • Midazolam is given to children before medical procedures or before anesthesia for surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event. (medlineplus.gov)
  • Midazolam that induces sleep and reduces anxiety in patients before surgery has been linked to a higher risk of heart illnesses when procedures are carried out at night. (justcarehealth.com)
  • Midazolam should not be administered by rapid injection in the neonatal population. (nih.gov)
  • 5. Midazolam has been used for executions 😳 The drug has been introduced for use in executions by lethal injection in certain jurisdictions in the United States in combination with other drugs. (combatmedicine101.com)
  • Midazolam injection is also used to sedate a patient who needs a ventilator. (astistrial.com)
  • Midazolam injection may also be used for purposes not listed in this medication guide. (astistrial.com)
  • Avoid drinking alcohol within the first 1 or 2 days after you receive midazolam injection. (astistrial.com)
  • Midazolam can cause extreme memory loss that may last for several hours after the injection. (astistrial.com)
  • Avoid driving or hazardous activity until the effects of midazolam have worn off completely, or until 24 hours after injection (whichever comes first). (astistrial.com)
  • Midazolam injection is for a single use, or for continuous infusion in a person on a ventilator. (astistrial.com)
  • The effects of midazolam on the CNS are dependent on the dose administered, the route of administration, and the presence or absence of other medications. (nih.gov)
  • 1] Two expert panels advocates waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing. (nih.gov)
  • Patients were randomly assigned to receive 0.035 mg/kg intravenous midazolam (low dose), 0.07 mg/kg (high dose), or placebo. (druglib.com)
  • 57% male) were included in the study (33 in the low-dose midazolam group, 34 in the high-dose midazolam group, and 33 in the placebo group). (druglib.com)
  • 3. It's often preferred over Diazepam 💉 Midazolam has a shorter onset of action and a shorter duration, making it a go-to medication for seizures in the ED. It can also be used bucally and nasally. (combatmedicine101.com)
  • Midazolam is a federally controlled substance (Schedule IV) as it has a risk of abuse, misuse, and addiction, which can lead to overdose or death. (cureepilepsy.org)
  • Confirmation of Hancock ordering two years' worth of a sedative called Midazolam from a French supplier. (substack.com)
  • tell your child's doctor and pharmacist if he or she is allergic to midazolam, any other medications, or cherries. (medlineplus.gov)
  • Midazolam is available as a generic medication. (wikipedia.org)
  • Do not allow your child to ride a bicycle, drive a car, or do other activities that require him or her to be fully alert for at least 24 hours after receiving midazolam and until the effects of the medication have worn off. (medlineplus.gov)
  • Midazolam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other central nervous system depressants as they also may slow your breathing. (cureepilepsy.org)
  • Midazolam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. (astistrial.com)
  • 4. It's not without risks though ☝ In healthy humans, 0.15 mg/kg of midazolam may cause respiratory depression, which is postulated to be a central nervous system (CNS) effect. (combatmedicine101.com)
  • Many other medications may also interact with midazolam, so be sure to tell your child's doctor about all the medications your child is taking, even those that do not appear on this list. (medlineplus.gov)
  • Using midazolam more frequently than recommended, even at recommended dosages, may increase these risks, especially when used in combination with other medications (e.g., opioids), alcohol, and/or illicit substances. (cureepilepsy.org)
  • Midazolam is sometimes used for the acute management of prolonged seizures. (wikipedia.org)
  • Midazolam, in combination with an antipsychotic drug, is indicated for the acute management of schizophrenia when it is associated with aggressive or out-of-control behaviour. (wikipedia.org)
  • Patients with acute narrow-angle glaucoma should not take midazolam. (cureepilepsy.org)
  • To study the stability and compatibility of dexamethasone 21 phosphate disodium salt and midazolam at various concentrations at 4C and 23C. (cjhp-online.ca)
  • This time around, it wasn't called the Liverpool Care Pathway but the protocol was identical: the use of a cocktail of drugs (usually Midazolam and morphine), along with a withdrawal of food and water, leading to the untimely death of the patient. (substack.com)
  • To evaluate the degree of drug-drug interaction concerning metabolic inhibition in the liver quantitatively, we tried to predict the plasma concentration increasing ratio (R) of midazolam (MDZ) by erythromycin (EM), diltiazem (DLZ), or verapamil (VER) in rats. (aspetjournals.org)
  • A potentially hazardous interaction between erythromycin and midazolam. (webmd.com)
  • 10.Hiller A, Olkkola KT, Isohanni P, Saarnivaara L. Unconsciousness associated with midazolam and erythromycin. (webmd.com)
  • 11.Wood M. Midazolam and erythromycin. (webmd.com)
  • Midazolam is available as a solution for a nasal route only and is administered by a healthcare provider for no more than 2 doses in an emergency setting. (cureepilepsy.org)
  • Midazolam administration via the sublingual in 1.2, 2.4, 4.8 mg/kg doses could induce only immobility (score = 4) in 100% of animals but all of cats in any doses react to pain. (vin.com)
  • Midazolam comes as a syrup to take by mouth. (medlineplus.gov)
  • 1.Midazolam Hydrochloride Syrup US Prescribing Information. (webmd.com)
  • Furthermore, 31 patients in the lorazepam group did not receive the active drug because of difficulty with intravenous access, whereas only 5 patients in the midazolam group did not receive drug owing to autoinjector failure. (medscape.com)
  • Midazolam in flexible bronchoscopy premedication: effects on patient-related and procedure-related outcomes. (druglib.com)
  • Save on Midazolam HCL at your pharmacy with the free discount below. (familywize.org)
  • Taking midazolam with certain other medicines may cause side effects or affect how well they work. (cureepilepsy.org)
  • The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants. (nih.gov)
  • Out of 665 patients who received midazolam -induced CS, 21 patients were administered IV Flumazenil . (bvsalud.org)
  • The ease of administration of midazolam more than made up for the fact that it was slower-acting (3.3 minutes) than lorazepam (1.6 minutes). (medscape.com)
  • Epilepsy Queensland's 'Understanding Epilepsy & Administration of Midazolam' training is designed to provide anyone with the core skills and knowledge to live well with epilepsy or to support someone who does. (humanitix.com)
  • A collaboration led by the Department of Health and Human Services (HHS) to facilitate activities, both research and regulatory, related to the Food and Drug Administration (FDA) approval of midazolam for use in treating nerve agent exposure. (nih.gov)
  • More midazolam-treated patients were seizure-free upon hospital arrival (73.4% for midazolam vs. 63.4% for lorazepam) -- a difference of 10 percentage points, which demonstrated the noninferiority and superiority of midazolam. (medscape.com)
  • However, during the first 24 h, both solutions remained clear and free of precipitate and retained 90% of the initial concentration of both dexamethasone and midazolam. (cjhp-online.ca)
  • Do not stop taking midazolam suddenly unless directed to do so by your healthcare provider. (cureepilepsy.org)
  • You should not stop using midazolam suddenly unless your healthcare provider tells you to stop the medicine because of a serious side effect. (cureepilepsy.org)
  • Talk to your healthcare provider about the signs and symptoms of midazolam addiction. (cureepilepsy.org)
  • Midazolam is injected into a muscle or vein by a healthcare provider. (astistrial.com)
  • Your blood levels of your midazolam may increase and cause excess drowsiness. (webmd.com)
  • Midazolam can also cause severe dizziness or drowsiness for up to 24 hours, or longer in older adults. (astistrial.com)
  • Pasienten kan komme inn i en ond spiral der tannbehandlingsangst leder til unngåelse av tannbehandling med dårlig oral helse som resultat. (tannlegetidende.no)
  • 5. Midazolam caused a decrease in the high-frequency and an increase in the low-frequency components of the power spectral density plot, and in addition reduced the mean R-R interval and R-R variability expressed as the interquartile difference, and pNN50. (portlandpress.com)